摘要
目的:探讨早期食管癌(early esophageal cancer,EEC)及癌前病变患者经内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)治疗后中重度疼痛的发生率及影响因素,为减轻术后疼痛、促进患者康复、提高护理满意度提供参考依据。方法:连续纳入宜宾市第二人民医院消化内科2023年1月至2024年12月期间收治的256例行ESD治疗的EEC及癌前病变患者作为研究对象,收集患者的一般资料、临床病理资料及术后疼痛评分,并按照术后是否发生中重度疼痛分为2组,采用单因素比较及多因素Logistic回归模型分析EEC及癌前病变患者行ESD治疗后发生中重度疼痛的相关影响因素。结果:256例患者平均疼痛NRS评分为(2.74±1.55)分,其中69例患者术后评估为中重度疼痛,发生率为26.95%(69/256)。单因素及多因素Logistic回归分析显示:男性(OR=2.565,95%CI:1.289~5.101,P=0.007)、病灶纵向长度≥5 cm(OR=2.345,95%CI:1.204~4.567,P=0.012)、浸润深度为SM(OR=3.902,95%CI:1.305~11.674,P=0.015)是影响EEC及癌前病变患者ESD术后发生中重度疼痛的独立危险因素。结论:ESD术后疼痛是EEC及癌前病变治疗中不可忽视的问题。ESD术后疼痛的发生受多种因素影响,性别、病变大小、浸润深度是其影响因素,针对不同影响因素,临床应采取个体化的术后管理策略。
Objective:To investigate the incidence and influencing factors of moderate-to-severe pain following endoscopic submucosal dissection(ESD)in patients with early esophageal cancer(EEC)and precancerous lesions,providing evidence for optimizing postoperative analgesia,enhancing recovery,and improving patient-reported satisfaction.Methods:The study consecutively enrolled 256 patients with EEC or precancerous lesions who underwent ESD at the Department of Gastroenterology,Yibin Second People's Hospital between January 2023 and December 2024.We collected patients'demographic characteristics,clinicopathologic data,and postoperative pain scores.Participants were divided into two groups according to whether moderate-to-severe pain occurred after surgery.Univariate analysis and multivariable logistic regression models were used to analyze factors influencing moder-ate-to-severe pain after ESD in patients with EEC and precancerous lesions.Results:The mean Numeric Rating Scale score among 256 patients was 2.74±1.55.Of these,69 patients were classified as having moderate-to-severe postoperative pain,yielding an incidence rate of 27.0%(69/256).Univariate and multivariable logistic regression analyses identified the following independent risk factors for moderate-to-severe pain after ESD in patients with EEC or precancerous lesions:male sex(OR=2.565,95%CI:1.289~5.101,P=0.007),lesion longitudinal length≥5 cm(OR=2.345,95%CI:1.204~4.567,P=0.012),and submucosal invasion(OR=3.902,95%CI:1.305~11.674,P=0.015).Conclusion:Postoperative pain following ESD constitutes a significant clinical concern in managing EEC and precancerous lesions.The development of post-ESD pain is associated with multiple factors,including patient sex,lesion dimensions,and depth of invasion.Therefore,implementing individualized postoperative analgesia strategies based on these determinants is essential in clinical practice.
作者
李倩
夏冬梅
黄萍
赵平
王洲丽
罗咏萍
Li Qian;Xia Dongmei;Huang Ping;Zhao Ping;Wang Zhouli;Luo Yongping(Department of Gastroenterology,Yibin Second People's Hospital(i.e.Yibin Hospital,West China Hospital,Sichuan University),Yibin 644000,Sichuan,China)
出处
《肿瘤预防与治疗》
2025年第8期712-718,共7页
Journal of Cancer Control And Treatment
基金
中国消化道早癌医师共同成长计划科研项目(编号:GTCZ-2023-5C-09)。
